Minimally invasive Dorsal cheilectomy and Hallux metatarsophalangeal joint arthroscopy for the treatment of Hallux Rigidus

Chase Gauthier; Thomas Lewis; John O'Keefe; Yianni Bakaes; Vikram Vignaraja; J Benjamin Jackson 3rd; Samuel Franklin; Jonathan Kaplan; Robbie Ray; Tyler Gonzalez

doi:10.1016/j.fas.2024.02.011

Minimally invasive Dorsal cheilectomy and Hallux metatarsophalangeal joint arthroscopy for the treatment of Hallux Rigidus

Foot Ankle Surg. 2024 Feb 28:S1268-7731(24)00039-0. doi: 10.1016/j.fas.2024.02.011. Online ahead of print.

Authors

Affiliations

¹ Prisma Health, Department of Orthopedic Surgery, 2 Medical Park Rd, Suite 404, Columbia, SC 29203, USA. Electronic address: chase.gauthier@prismahealth.org.
² King's College Hospital NHS Foundation Trust, Department of Orthopedic Surgery, Denmark Hill, London SE5 9RS, USA. Electronic address: t.lewis2@nhs.net.
³ Prisma Health, Department of Orthopedic Surgery, 2 Medical Park Rd, Suite 404, Columbia, SC 29203, USA.
⁴ Prisma Health, Department of Orthopedic Surgery, 2 Medical Park Rd, Suite 404, Columbia, SC 29203, USA. Electronic address: yianni.bakaes@prismahealth.org.
⁵ King's College Hospital NHS Foundation Trust, Department of Orthopedic Surgery, Denmark Hill, London SE5 9RS, USA. Electronic address: Vikram.vignaraja@nhs.net.
⁶ Prisma Health, Department of Orthopedic Surgery, 2 Medical Park Rd, Suite 404, Columbia, SC 29203, USA. Electronic address: jbenjackson@gmail.com.
⁷ King's College Hospital NHS Foundation Trust, Department of Orthopedic Surgery, Denmark Hill, London SE5 9RS, USA. Electronic address: Samuel.franklin@nhs.net.
⁸ Duke University Medical Center, Orthopedic Surgery, 4709 Creekstone Drive, Durham, NC 27703, USA. Electronic address: jkaplan26@gmail.com.
⁹ King's College Hospital NHS Foundation Trust, Department of Orthopedic Surgery, Denmark Hill, London SE5 9RS, USA. Electronic address: robbie1ray1@gmail.com.
¹⁰ King's College Hospital NHS Foundation Trust, Department of Orthopedic Surgery, Denmark Hill, London SE5 9RS, USA. Electronic address: tyleragonzalezmed@gmail.com.

PMID: 38458913
DOI: 10.1016/j.fas.2024.02.011

Abstract

Background: Minimally invasive dorsal cheilectomy (MIDC) has become a popular alternative to an open approach for treating Hallux Rigidus (HR). To reduce some of the complications related to the MIDC approach, a first metatarsophalangeal (MTP) joint arthroscopy can be performed in addition to address the intra-articular pathology associated with Hallux Rigidus. This study aims to examine the effectiveness of MIDC with first MTP arthroscopy in patients with HR with a minimum 1-year follow-up.

Methods: This was a multicenter retrospective review for adult patients with Coughlin and Shurnass Grade 0-3 who were treated with MIDC and first MTP arthroscopy between 3/1/2020 and 8/1/2022, with at least one year of follow-up data. Demographic information, first MTP range of motion (ROM), visual analog scale (VAS), Manchester-Oxford Foot Questionnaire (MOXFQ), and EQ-5D-5 L scores were collected. Continuous data was expressed as a mean and standard deviation, categorical data was expressed as a percentage. Wilcoxon Rank Sum test was used to compare continuous variables. All P < 0.05 was considered significant.

Results: A total of 31 patients were included in the study. Average follow-up time was 16.5 months (range: 12 to 26.2). There was 1 (3.2%) undersurface EHL tendon tear, 2 (6.5%) conversions to an MTP fusion, and 1 (3.2%) revision cheilectomy and capsular release for MTP joint contracture. There was a significant improvement in patient's ROM in dorsiflexion (50 vs 89.6 degrees, P = 0.002), postoperative VAS pain scores (6.4 vs 2.1, P < 0.001), MOXFQ pain scores (58.1 vs 30.7, P = 0.001), MOXFQ Walking/Standing scores (56.6 vs 20.6, P = 0.001), MOXFQ Social Interaction scores (47.3 vs 19.36, P = 0.002), and MOXFQ Index scores (54.7 vs 22.4, P < 0.001).

Conclusion: We found that MIDC with first MTP arthroscopy was effective at improving patient-reported outcomes at one year with low complication and revision rates. These results suggest that MIDC with first MTP arthroscopy is an effective treatment for early-stage HR.

Level of evidence: IV.

Keywords: Complications; First metatarsophalangeal arthroscopy; Forefoot surgery; Hallux Rigidus; Minimally Invasive Dorsal Cheilectomy; Osteoarthritis; Patient reported outcomes; Percutaneous surgery.